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Door Opens to Health Claims Tied to Agent Orange

- Oct 14 2009

By James Dao

Under rules to be proposed this week, the Department of Veterans Affairs plans to add Parkinson’s disease, ischemic heart disease and hairy-cell leukemia to the growing list of illnesses presumed to have been caused by Agent Orange, the toxic defoliant used widely in Vietnam.

The proposal will make it substantially easier for thousands of veterans to claim that those ailments were the direct result of their service in Vietnam, thereby smoothing the way for them to receive monthly disability checks and health care services from the department.

The new policy will apply to some 2.1 million veterans who set foot in Vietnam during the war, including those who came after the military stopped using Agent Orange in 1970. It will not apply to sailors on deep-water ships, though the department plans to study the effects of Agent Orange on the Navy.

The shift underscores efforts by the secretary of veterans affairs, Eric Shinseki, a retired Army chief of staff and a Vietnam veteran himself, to reduce obstacles to sick or disabled veterans’ receiving benefits. The department has come under sharp criticism from Congress and veterans groups for long delays in processing disability claims.

“Since my confirmation as secretary, I’ve often asked why, 40 years after Agent Orange was last used in Vietnam, we’re still trying to determine the health consequences to our veterans who served in the combat theater,” Mr. Shinseki said in a statement. “Veterans who endure a host of health problems deserve timely decisions.”

The veterans department already recognizes more than a dozen conditions as being presumptively connected to Agent Orange exposure in Vietnam, including Hodgkin’s disease, prostate cancer and Type 2 diabetes.

But for diseases not on that list, veterans are required to provide evidence directly relating their service in Vietnam to their illness, a requirement that often leads to application rejections and prolonged appeals.

Veterans department officials estimate that about 200,000 veterans might seek benefits under the proposed change in policy. But they said they could not estimate the cost of the change until the policy underwent public review and was published in final form, which could take several months.

Mr. Shinseki’s decision is a victory for groups like Vietnam Veterans of America, which has been pushing the department to add Parkinson’s disease, ischemic heart conditions and hypertension to the list of diseases presumptively linked to Agent Orange.

But the new policy is also likely to prompt debate over how much responsibility the federal government should take in compensating and caring for aging veterans who are exhibiting a growing list of physical and psychological problems.

The most common of the three illnesses, ischemic heart disease, restricts blood flow to the heart, causing irregular heartbeats and deterioration of the heart muscle.

Parkinson’s disease is associated with a loss of cells that secrete dopamine, a brain chemical essential for normal movement. Patients develop tremors, rigid posture, impaired balance and an inability to initiate movement.

Hairy-cell leukemia, a rarer condition, is a slow-growing cancer in which the bone marrow produces too many infection-fighting cells, lymphocytes, that crowd out healthy white blood cells, red blood cells and platelets.

Agent Orange, named after the color-coded band on storage drums, was the most common herbicide used in Vietnam to clear jungle canopy and destroy crops. It contained one of the most toxic forms of dioxin, which has since been linked to some cancers.

Aides said Mr. Shinseki’s decision was influenced by a report released in July from the Institute of Medicine that found “limited or suggestive evidence” of an association between exposure to herbicides and an increased chance of Parkinson’s disease and ischemic heart disease in Vietnam veterans. The report also found “sufficient evidence,” a stronger category, of an association between herbicides and hairy-cell leukemia.

The report, written by a 14-member panel appointed by the institute, was based on a review of scientific literature. The institute is required by Congress to monitor the health effects of herbicides used in Vietnam and produce updates every two years.

In its report, the panel warned that there was a paucity of epidemiological data about Vietnam veterans. As a result, the panel said, its findings did not represent “a firm conclusion” about herbicides and Parkinson’s and herbicides and ischemic heart disease. It said it could not estimate the chances of veterans’ developing either disease.

Despite those caveats, the Institute of Medicine report has been cited by veterans advocates as providing sufficient evidence to justify a rule change. Under laws governing Agent Orange policies for veterans, the department cannot make benefits decisions based on cost, only on the scientific evidence. Aides to Mr. Shinseki said the Institute of Medicine report provided that evidence.

Some doctors and researchers say the expansion of Agent Orange benefits has been based on weak or inconclusive science, given the lack of studies on Vietnam veterans. Those skeptics argue that diseases like prostate cancer or Type-2 diabetes are just as likely the result of aging, lifestyle or genetic predisposition as exposure to Agent Orange.

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For more information on this topic, see PDF's Fall 2009 newsletter article, Environmental Factors and PD, which dicusses the Institute of Medicine report mentioned above regarding the health effects of herbicide exposure among Vietnam veterans.